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Better technology can bring better care -- and higher costs

A new study examines whether innovations in health care technology are too much of a good thing.

By Susan J. Landers, amednews staff. Dec. 15, 2003.

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Washington -- Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, remembers when there was only one CT scanner in Worcester, Mass., where she received her medical training. When patients needed scans they were transported to the CT site via ambulance.

Flash forward 20 years, and CT scanners are now where the patients are. Nearly 80% of hospitals have their own CT equipment, and more than 50% have their own MRI scanners, according to the American Hospital Assn.

This is good news for physicians and patients. CT and MRI scans were selected as the most valuable of medical innovations in a 2001 survey of primary care physicians.

But it also could be too much of a good thing. It has long been known that the costly scanners, as well as the many other technological advances -- such as those that help tiny babies survive and allow diabetic patients to better monitor their blood sugar levels -- are driving up health care costs.

A study in the November/December Health Affairs examined the relationship between the increasing availability of technology and health care spending and found that "if you build it, they will come," said lead author Laurence Baker, PhD, an associate professor of health research and policy at Stanford University School of Medicine.

However, in studying diagnostic imaging, cardiac care, cancer care and newborn care, the researchers found that not all technologies resulted in the same patterns of use.

Although the greater availability of diagnostic imaging and cardiac care led to higher use and greater spending, increased availability of PET scanners in cancer care was associated with greater use but not greater spending.

The study also found that an inconsistent relationship between the availability of neonatal intensive care units and spending for newborn care.

Many in the health care arena also believe that technology-driven increases in spending do not result in higher quality.

For example, a new disposable device has been introduced that does the job of an ice pack after arthroscopic surgery but at a much higher cost -- $1,000 -- said Dale Andringa, MD, vice president and chief medical officer at Wellmark Blue Cross Blue Shield.

There also is a tendency to use MRI instead of an x-ray to diagnose a sprained ankle, raising the cost from about $50 to $1,000, he said.

"We need to seriously evaluate the benefits of individual new technologies before encouraging their use," said Howard Birnbaum, PhD, vice president of the Analysis Group Inc., a Boston consulting firm and a co-investigator of the study. "Optimal policies will recognize the attributes of specific technologies and acknowledge that 'one-size-fits-all' policies could easily backfire."

Weighing risks

Dr. Clancy praised the study's focus on the need to evaluate technology. "We know very little of the benefits and potential harms of some of these technologies," she said. "There is a need for practical clinical trials that answer such questions as, 'Is this worth paying for?' and 'What are the expected benefits?' "

Molly Joel Coye, MD, MPH, founder of the nonprofit Health Technology Center, said technology now being introduced ensures that health care costs will continue to rise.

"But it is important to remember that many new technologies in medicine do indeed save money," she said. "We should aggressively search for the technologies that will reduce costs and then support their rapid dissemination and adoption."

The researchers also found that the availability of technology had different cost implications depending on whether an individual was privately insured or covered by Medicare.

For example, as CT and MRI scanners became more available, prices for scans rose higher for Medicare beneficiaries than for patients who were insured privately. The authors suggest that one reason for this fee difference might be that commercial markets allow for more competitive prices, while Medicare must adhere to an administratively run pricing system.

"Medicare is already seriously challenged by rising health care costs, and pressure from new technologies seems like it will squeeze things further," said Dr. Baker.

"This is just one added reason why we must really assess the value of the new technologies."

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